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Langenbeck's Archives of Surgery

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01-03-2020 | Original Articles

How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting

Authors: Andreas D. Rink, Peter Kienle, Felix Aigner, Alexis Ulrich

Published in: Langenbeck's Archives of Surgery | Issue 2/2020

Abstract

Aims

Anastomotic leakage is one of the most worrisome complications in colorectal surgery. An expert meeting was organized to discuss and find a consensus on various aspects of the surgical management of colorectal disease with a possible impact on anastomotic leakage.

Methods

A three-step Delphi-method was used to find consensus recommendations.

Results

Strong consensus was achieved for the use of mechanical bowel preparation and oral antibiotics prior to colorectal resections, the abundance of non-selective NSAIDs, the preoperative treatment of severe iron deficiency anemia, and for attempting to improve the patients’ general performance in the case of frailty. Concerning technical aspects of rectal resection, there was a strong consensus in regard to routinely mobilizing the splenic flexure, to dividing the inferior mesenteric vein, and to using air leak tests to check anastomotic integrity. There was also a strong consensus on not to oversew the stapled anastomoses routinely, to use protective ileostomies for low rectal and intersphincteric, but not for high-rectal anastomoses. Furthermore, a consensus was reached in regard to using CT-scans with rectal contrast enema to evaluate suspected anastomotic leakage as well as measuring C-reactive protein routinely to monitor the postoperative course after colorectal resections. No consensus was found concerning the indication and technique for testing bowel perfusion, the routine use of endoscopy to check the integrity of the anastomosis, the placement of transanal drains for rectal anastomoses and the management of anastomotic leakage with peritonitis.

Conclusion

Consensus could be found for several practice details in the perioperative management in colorectal surgery that might have an influence on anastomotic leakage.

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Title: How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting
Authors: Andreas D. Rink
Peter Kienle
Felix Aigner
Alexis Ulrich
Publication date: 01-03-2020
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01864-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

How to reduce anastomotic leakage in colorectal surgery—report from German expert meeting

Abstract

Aims

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims

Methods

Results

Conclusion

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